Drill guide with rotating handle

ABSTRACT

A drill guide includes at least one drill guide lumen and a handle coupled to the at least one drill guide lumen. The drill guide lumen includes a proximal opening, a distal opening, and a longitudinal opening therebetween. The handle is movable between a first position relative to the drill guide lumen and a second position relative to the drill guide lumen.

BACKGROUND OF THE INVENTION

1. Field of the Invention

The invention relates generally to systems and methods for performingspinal fixation. Specifically, the invention relates to drill guides,particularly those used for orthopedic procedures.

2. Description of the Related Art

Advancing age, as well as injury, can lead to degenerative changes inthe bones, discs, joints, and ligaments of the spine, producing pain andinstability. Under certain circumstances, alleviation of the problemscan be provided by performing spinal fusion. Spinal fusion is a surgicaltechnique in which two or more vertebrae of the spinal column are fusedtogether to eliminate the motion between the fused vertebrae. Spinalfusion is used to treat conditions where the spine exhibits instability.Spine instability may result from causes such as fracture, scoliosis,and spondylolisthesis, where one or more vertebrae move in a forwarddirection relative to the other vertebrae. Spinal fusion with discectomyis also performed for herniations of the discs. This surgery involvesremoval of the affected disc and fusion of the adjacent vertebrae.Traditionally, bone grafts have been used to fuse the vertebrae, butvarious types of vertebral implants have also been used.

The use of bone fixation systems for treating bone conditions is wellestablished. For example, a bone plate may be positioned over andsurrounding the bone injury area and secured to the bone. The bone platecan be secured to the bone by bone screws or other similar fastenersinserted through holes in the bone plate and into the bone itself,sometimes positioned with a drill guide. The screws are tightened sothat the bone plate holds the bone to be treated in place in order toinsure proper healing. Early fixation devices tended to be applicableonly to long-bone injuries, with only limited uses for lower lumbarspinal injuries and disorders. The use of plate/screw fixation systemslater expanded, however, to include uses for spinal injuries, includingfusion of vertebrae and fixation devices for treating cervical vertebraeinjuries.

SUMMARY OF THE INVENTION

In one embodiment, the present invention provides a drill guidecomprising at least one drill guide lumen and a handle coupled to the atleast one drill guide lumen. The drill guide lumen includes a proximalopening, a distal opening, and a longitudinal opening therebetween. Thehandle is movable between a first position relative to the drill guidelumen and a second position relative to the drill guide lumen.

The drill guide may further comprise an elongate member including afirst end, a second end, and a longitudinal axis therebetween, whereinthe at least one drill guide lumen is mechanically coupled proximate tothe first end of the elongate member and wherein the handle ismechanically coupled proximate to the second end of the elongate member.The drill guide may further comprise a plurality of drill guide lumenscoupled to the handle. The handle may be configured to rotate betweenthe first position and the second position.

The first position may comprise a first angular position of the handlerelative to the at least one drill guide lumen and the second positionmay comprise a second angular position of the handle relative to the atleast one drill guide lumen. The handle may be configured with a fixedangular position transverse to the longitudinal opening of the at leastone drill guide lumen.

The first position may comprise a first angular position of the handletransverse to the longitudinal opening of the at last one drill guidelumen and the second position may comprise a second angular position ofthe handle transverse to the longitudinal opening of the at least onedrill guide lumen. The handle may be configured with a fixed angularposition relative to the at least one drill guide lumen.

The handle may be movably coupled to the at least one drill guide lumenwith a locking mechanism. The handle may be movable between the firstposition and the second position in an unlocked state an immovablebetween the first position and the second position in a locked state.The locking mechanism may comprise a bushing including a plurality ofrecesses and a collar disposed around the bushing. The collar mayinclude a flange configured to at least partially fill at least one ofthe plurality of recesses when the handle is in the locked state. Thebushing may be mechanically coupled to the drill guide lumen with afastener. The plurality of recesses may be configured to permit rotationof the handle in a first direction and may be configured to limitrotation of the handle in a second direction substantially opposite thefirst direction. The handle may be configured to transition between thelocked state when the flange at least partially fills at least one ofthe plurality of recesses and the unlocked state when the flange doesnot at least partially fill at least one of the plurality of recesses.The locking mechanism may comprise a threaded lock including a knob anda threaded portion. The threaded portion may be configured to engage athreaded portion of the handle. The threaded portion may be configuredto engage a threaded portion of a drill guide lumen extending throughthe handle. The threaded portion may be configured to engage a threadedportion of the elongate member extending through the handle. The handlemay be configured to transition between the locked state and theunlocked state by manipulating a button. The handle may be configured totransition between the locked state and the unlocked state bymanipulating a lever, switch or knob.

The first position may comprise a first translational position of thehandle relative to the at least one drill guide lumen and the secondposition may comprise a second translational position of the handlerelative to the at least one drill guide lumen. The handle may beconfigured to slide between the first translational position and thesecond translational position.

In another embodiment, the present invention provides a method ofpositioning a drill guide lumen having a longitudinal axis. The methodcomprises providing a drill guide lumen mechanically coupled to amovable handle, positioning the drill guide lumen with the handle in afirst position, and moving the handle from the first position to asecond position while the drill guide lumen remains substantiallystationary.

Moving the handle may comprise rotating the handle from the firstposition to the second position, rotating the handle about a pivot pointon the drill guide lumen, translationally sliding the handle, and/ormanipulating a locking mechanism. The method may further comprise usinga drill to insert a bone screw through the drill guide lumen.

For purposes of summarizing the invention and the advantages achievedover the prior art, certain objects and advantages of the invention havebeen described herein above. Of course, it is to be understood that notnecessarily all such objects or advantages may be achieved in accordancewith any particular embodiment of the invention. Thus, for example,those skilled in the art will recognize that the invention may beembodied or carried out in a manner that achieves or optimizes oneadvantage or group of advantages as taught or suggested herein withoutnecessarily achieving other objects or advantages as may be taught orsuggested herein.

All of these embodiments are intended to be within the scope of theinvention herein disclosed. These and other embodiments will becomereadily apparent to those skilled in the art from the following detaileddescription of the preferred embodiments having reference to theattached figures, the invention not being limited to any particularpreferred embodiment(s) disclosed.

BRIEF DESCRIPTION OF THE DRAWINGS

These and other features, aspects, and advantages of the inventiondisclosed herein are described below with reference to the drawings ofpreferred embodiments, which are intended to illustrate and not to limitthe invention.

FIGS. 1A through 1C depict a perspective view of one embodiment of adrill guide with a handle in different positions.

FIG. 2 is an expanded perspective view of one embodiment of a movablecoupling.

FIG. 3 is a disassembled view of the movable coupling of FIG. 2.

FIG. 4A is an expanded disassembled view of the movable coupling of FIG.2.

FIG. 4B is an expanded disassembled view of another embodiment of amovable coupling.

FIG. 4C is a cross-sectional view of the components of the movablecoupling of FIG. 4B taken along lines 4C-4C.

FIGS. 5A and 5B depict a cross-sectional view of one embodiment of alocking mechanism in the locked and unlocked states, respectively.

FIGS. 6A and 6B depict a perspective view of another embodiment of adrill guide with a handle in different positions.

FIG. 7 is a cross-sectional view of the components of yet anotherembodiment of movable coupling.

FIG. 8 is a cross-sectional view of the components of still anotherembodiment of movable coupling.

FIG. 9 is a cross-sectional view of yet still another embodiment of amovable coupling.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

Although certain preferred embodiments and examples are disclosed below,it will be understood by those in the art that the invention extendsbeyond the specifically disclosed embodiments and/or uses of theinvention and obvious modifications and equivalents thereof. Thus, it isintended that the scope of the invention herein disclosed should not belimited by the particular disclosed embodiments described below.

As described above, devices such as bone plates or other orthopedicdevices can be secured to a bone by bone screws inserted through thedevice. The insertion of the bone screws may be directed by a drillguide for more precise placement. The drill guide typically comprises adrill guide lumen mechanically coupled to an elongate member, which ismechanically coupled to a handle. The handle provides addedmaneuverability such that the user may position the drill guide lumenmore accurately.

Fixation procedures are often performed by two or more people. Incertain embodiments, one user positions the drill guide lumen and theother user operates a drill to insert the bone screws into the boneplate and the bone, guided by the drill guide lumen. However, a handlein a fixed position may impede the ability of the user operating thedrill in accessing the drill guide lumen. For example, the handle or theappendages of the user positioning the drill guide may impede access toor visibility of the drill guide lumen, for example by blocking anopening in the drill guide lumen. At least one embodiment of the presentinvention is the realization that providing a handle movably coupled tothe drill guide lumen allows suitable positioning and holding of thedrill guide lumen while permitting unimpeded use of the drill.

FIG. 1A depicts a perspective view of one embodiment of a drill guide 10with a handle 24 movably coupled to a drill guide lumen 18. The drillguide 10 comprises an elongate member 12 including a first end 14, asecond end 16, and a longitudinal axis therebetween. At least one drillguide lumen 18 is coupled proximate to the first end 14 of the elongatemember 12. The drill guide lumen 18 includes a proximal opening 22, adistal opening 20, and a longitudinal opening therebetween. It will beappreciated that the drill guide lumen 18 may comprise any shapesuitable for accurately guiding a drill kit, including embodimentswithout an elongate member 12.

Although the embodiment of the drill guide 10 illustrated in FIG. 1Acomprises two drill guide lumens 18, the drill guide 10 may comprise anynumber of drill guide lumens 18 appropriate for the performed procedure.For example, if a procedure requires four bone screws to be insertedinto a bone plate, the drill guide 10 may comprise four drill guidelumens 18 such that the bone screws may be inserted into the bone plateand the bone after a single positioning the drill guide, therebyproviding greater procedural accuracy for placement of the bone screws.In some embodiments, a drill guide with fewer lumens than theimplantable device may be moved about the device after drill each lumenor sets of lumens.

In some embodiments, the first end 14 of the elongate member 12 isconfigured to receive any of a plurality of drill guide lumenassemblies. For example, a single drill guide may be able to receiveboth a drill guide lumen assembly with one drill guide lumen and a drillguide lumen assembly with two drill guide lumens. For another example, asingle drill guide would be able to receive both a drill guide lumenassembly with two drill guide lumens arranged in one configuration and adrill guide lumen assembly with two drill guide lumens arranged inanother configuration. Suitable assemblies, such as threading andsnap-on fittings, are well-known in the mechanical arts.

The drill guide 10 further comprises a handle 24 mechanically coupledproximate to the second end 16 of the elongate member 12 by movablecoupling 30. In alternative embodiments, the elongate member 12 ismechanically coupled to the at least one drill guide lumen 18 with amovable coupling, thereby providing a handle 24 movably coupled to thedrill guide lumen 18. In certain embodiments, both the mechanicalcoupling between the drill guide lumen 18 and the elongate member 12 andthe mechanical coupling between the elongate member 12 and the handle 24comprise movable couplings, as described in more detail below. Thehandle 24 may comprise areas for enhanced gripping, for example a griparea 28 and/or a contour area 26. In some embodiments, the handle 24 iscylindrical. In alternative embodiments, the handle 24 is shapedcontoured to a human hand, for example by providing finger and thumbrecesses.

FIG. 1B depicts a perspective view of the drill guide 10 of FIG. 1A withthe handle 24 in a different position. The movement of the handle 24from the position of FIG. 1A to the position of FIG. 1B is described inmore detail with respect to the movable coupling 30 below. In someembodiments, the handle 24 is configured to move between the firstposition of FIG. 1A and second position of FIG. 1B by rotation. Thepositions of the handle 24 in FIGS. 1A and 1B are provided forillustrative purposes only. For example, FIG. 1C depicts a perspectiveview of the drill guide 10 of FIG. 1A with the handle 24 in a positiondifferent than the positions of FIGS. 1A and 1B. It will be appreciatedthat the first position may be any position suitable for properlypositioning the drill guide lumen 18, and that the second position maybe any position suitable for providing secure positioning of the drillguide lumen 18 while also permitting unimpeded access to the drill guidelumen 18. In certain embodiments, the first position of the handle 24comprises a first angular position relative to the drill guide lumen 18and the second position of the handle 24 comprises a second angularposition relative to the drill guide lumen 18. For example, in theembodiments illustrated in FIGS. 1A and 1B, the first position Y of FIG.1A is about 90° from the second position Y′ of FIG. 1B. For anotherexample, in the embodiments illustrated in FIGS. 1A and 1C, the firstposition of FIG. 1A is about 90° from the second position of FIG. 1C.For yet another example, in the embodiments illustrated in FIGS. 1B and1C, the first position of FIG. 1B is about 180° from the second positionof FIG. 1C. In some embodiments, the handle 24 is configured to rotatecontinuously 360° about the movable coupling 30. In other embodiments,rotation may be restricted to a particular movement range.

In certain embodiments, the handle 24 is configured with a fixed angularposition transverse to the longitudinal axis of the elongate member 12or to the drill guide lumen 18. For example, in the embodimentillustrated in FIG. 1A, Angle X between the handle 24 and the elongatemember 12 may be approximately a 135° angle. In other positions, thehandle 24 would continue to be at approximately a 135° angle transverseto the longitudinal axis of the elongate member 12 or the drill guidelumen 18. The angular position Y relative to the drill guide lumen 18would change, for example from 0° as depicted in FIG. 1 to 90°, 180°,270°, or any suitable angle. It will be appreciated that the fixedangular position between the handle 24 and the elongate member 12 or thedrill guide lumen 18 may be any angle suitable for positioning the drillguide lumen 18, and that the movable coupling 30 can be adapted tomaintain the fixed angular position between the handle 24 and theelongate member 12 or the drill guide lumen 18. In embodimentscomprising an elongate member 12 in which the handle 24 is secured at afixed angular position to the elongate member 12 or to the drill guidelumen 18, the mechanical coupling of the drill guide lumen 18 to theelongate member 12 may be at an angle that compensates for the fixedangular position of the handle 24 transverse to the elongate member 12.

In other embodiments, the handle 24 is movable from a first angularposition relative to a pivot point on the longitudinal axis of theelongate member 12 or the drill guide lumen 18 to a second angularposition relative to the pivot point on the longitudinal axis of theelongate member 12 or the drill guide lumen 18. For example, a handle 24may be movable about a pivot point proximate to the second end 16 of theelongate member 12 such that the angular position relative to thelongitudinal axis of the elongate member 12 can change from about 135°to 90°, 180°, etc., such that the handle 24 may provide stablepositioning of the drill guide lumen 18 while not impeding access to thedrill guide lumen 18.

In certain embodiments, the handle 24 is configured with a fixed angularposition relative to the drill guide lumen 18. For example, in theembodiment illustrated in FIG. 1A, the handle 24 is secured atapproximately a 0° angle from the drill guide lumen 18. In otherpositions, the handle 24 would continue to be at approximately a 0°angle. The angular position transverse to the longitudinal axis of theelongate member 12 or to the drill guide lumen 18 would change, forexample from 135° as depicted in FIG. 1 to 0°, 180°, 360°, or any angletherebetween. It will be appreciated that the fixed angular positionbetween the handle 24 and the drill guide lumen 18 may be any anglesuitable for positioning the drill guide lumen 18. In embodimentscomprising an elongate member 12 in which the handle 24 is secured at afixed angular position to the elongate member 12 or to the drill guidelumen 18, the mechanical coupling of the drill guide lumen 18 may be atan angle to compensate for the angle of the fixed angular position ofthe handle 24 to the elongate member 12 or the drill guide lumen 18.

FIG. 2 depicts an expanded perspective view of one embodiment of amovable coupling 30 in which the handle 24 is movably coupled proximateto the second end 16 of the elongate member 12 or the drill guide lumen18 with a locking mechanism. The locking mechanism permits the handle 24to move between a first position and a second position relative to theelongate member 12 or the drill guide lumen 18 in an unlocked state anddoes not permit movement of the handle 24 relative to the elongatemember 12 between the first position and the second position in a lockedstate (e.g., as depicted in FIG. 2). In the illustrated embodiment, themovable coupling 30 comprises a bushing 40 mechanically coupledproximate to the second end 16 of the elongate member 12 and a collar 32disposed at least partially around the bushing 40.

FIGS. 3 and 4A are disassembled views of the movable coupling 30 of FIG.2. The bushing 40 comprises a plurality of recesses 42. In someembodiments, the bushing 40 comprises an aperture 39 through which arivet 38 or any suitable fastening device may mechanically couple thebushing 40 proximate to the second end 16 of the elongate member 12. Thecollar 32 comprises a flange 34 configured to engage at least one of theplurality of recesses 42 of the bushing 40 when the handle 24 is in alocked state. For example, the illustrated flange 34 of the collar 32 isconfigured to fit at least partially within at least one of theplurality of recesses 42 of the bushing 40, thereby locking the handle24 in place. In some embodiments, the plurality of recesses 42 areconfigured to permit rotation in a first angular direction of the handle24 and are configured to limit rotation in a second angular directionsubstantially opposite the first angular direction, such as in a socketwrench system (e.g., as depicted in FIGS. 4B and 4C). In alternativeembodiments, the bushing 40 comprises a plurality of flanges and thecollar 32 comprises a recess configured to be at least partially filledby at least one of the plurality of flanges. In other alternativeembodiments, the bushing 40 and the collar 32 comprise a set ofinterlocking teeth.

As described above, the handle 24 is configured to be movable betweenthe locked state and the unlocked state when the collar 32 is positionedsuch that the flange 34 engages and disengages, respectively, at leastone of the plurality of recesses 42 of the bushing 40. In oneembodiment, the movable coupling 30 further comprises a spring 36bearing against the collar 32 and a button 46. FIG. 5A illustrates amovable coupling 30 in a locked state wherein the flange 34 at leastpartially fills at least one of the plurality of recesses 42. In thisstate, the handle 24 resists movement between a first position and asecond position relative to the elongate member 12. FIG. 5B illustratesthe movable coupling 30 in an unlocked state with the button 46 engaged(as depicted by arrows 48). When engaged, the button 46 is manipulatedto compress the spring 36, causing the collar 32 to move away from thebushing 40, thereby disengaging the flange 34 from the at least one ofthe plurality of recesses 42 in the bushing 40. In alternativeembodiments, the position and spring constant of the spring 36 arereversed such that engaging the button 46 extends the spring 36, causingthe collar 32 to move away from the bushing 40, thereby disengaging theflange 34 from the at least one of the plurality of recesses 42 in thebushing 40.

Although the button 46 depicted in FIG. 2 is located at one end of thehandle 24, it will be appreciated that the button 46 may be positionedat any suitable location on the handle 24 such that manipulation of itcauses the collar 32 to engage and/or disengage with the bushing 40. Forexample, the button 46 may comprise a wedge positioned on the handle 24substantially opposite the elongate member 12 that, when verticallymanipulated, causes translational movement of the collar 32. It will beappreciated that similar locking and unlocking operation may be achievedby providing a lever or switch rather than a button 46 to engage anddisengage the collar 32 from the bushing 40.

As described above, the movable coupling 30 may be provided at themechanical coupling of the elongate member 12 and the drill guide lumen18 with similar operation. Rather than the handle 24 moving while theelongate member 12 and the drill guide lumen 18 remain substantiallystationary, in such embodiments the handle 24 and the elongate member 12move while the drill guide lumen 18 remains substantially stationary.Embodiments are also possible in which each of the mechanical couplingscomprise a movable coupling such that the handle 24 and the elongatemember 12 can move independently while the drill guide lumen 18 remainssubstantially stationary. In each of the described embodiments, thehandle 24 is movable relative to the drill guide lumen 18.

FIG. 6A depicts an embodiment of a drill guide 50. The drill guide 50comprises a handle 24 configured to slide between a first translationalposition relative to the drill guide lumen 18 (e.g., as depicted in FIG.6A) and a second translational position relative to the drill guidelumen 18 (e.g., as depicted in FIG. 6B). The arrows 56, 58 illustratethe direction of movement of the handle 24 between the positionsdepicted in FIGS. 6A and 6B, respectively. In some embodiments, thehandle 24 comprises slide-stops 52, 54 to prevent the handle 24 fromfully sliding through the movable coupling 30. In other embodiments, thehandle 24 is tapered outwards at the ends to prevent the handle 24 fromfully sliding through the movable coupling 30.

FIG. 7 is a cross-sectional view of the components of yet anotherembodiment of a movable coupling 30. The movable coupling 30 comprisesthe second end 16 of the elongate member 12, the handle 24, and athreaded lock 60. The second end 16 of the elongate member 12 is shapedsuch that a hollow area 25 of the handle 24 may fit around the elongatemember 12 without sliding down, for example with stepped-in area 17. Atleast a portion 27 of the hollow area 25 of the handle 24 distal to theelongate member 12 is threaded to engage the threaded lock 60. Thethreaded lock 60 comprises a knob 62 and a threaded area 64. Thethreaded area 64 of the threaded lock 60 is adapted to engage thethreads of the portion 27 of the hollow area 25 of the handle 24, forexample when the knob 62 is turned. When the threaded lock 60 is notengaged, the handle 24 may freely rotate about the elongate member 12.When the threaded lock 60 is engaged (e.g., by being substantiallyscrewed into the hollow area 25 of the handle 24), an edge 65 of thethreaded lock 60 bears against the top 13 of the elongate member 12,thereby limiting the rotation of the handle 24. In some embodiments, theedge 65 of the threaded lock 60 and/or the top 13 of the elongate member12 include teeth, grit, or similar members to enhance effects of therotation limitation. In some embodiments, a material or layer thatenhances the effects of rotation limitation is inserted between the top13 of the elongate member 12 and the edge 65 of the threaded lock 60. Itwill be appreciated that the end of the drill guide lumen 18 assemblymay be similarly shaped such that rotation of the handle 24 may belimited by a threaded lock 60 without an elongate member 12.

FIG. 8 is a cross-sectional view of the components of still anotherembodiment of a movable coupling 30. The movable coupling 30 comprisesthe second end 16 of the elongate member 12, the handle 24, and athreaded lock 60. The second end 16 of the elongate member 12 is shapedsuch that a hollow area 25 of the handle 24 may fit around the elongatemember 12 without sliding down, for example with stepped-in area 17. Atleast a portion 21 of the second end 16 of the elongate member 12 isthreaded to engage the threaded lock 60. The threaded lock 60 comprisesa knob 62 and a threaded area 66. The threaded area 66 of the threadedlock 60 is adapted to engage the threads of the portion 21 of the secondend 16 of the elongate member 12, for example when the knob 62 isturned. When the threaded lock 60 is not engaged, the handle 24 mayfreely rotate about the elongate member 12. When the threaded lock 60 isengaged (e.g., by being substantially screwed onto the second end 16 ofthe elongate member 12), edges 68 of the threaded lock 60 bears againstthe top 29 of the handle 24, thereby limiting the rotation of the handle24. In some embodiments, the edges 68 of the threaded lock 60 and/or thetop 29 of the handle 24 include teeth, grit, or similar members toenhance effects of the rotation limitation. In some embodiments, amaterial or layer that enhances the effects of rotation limitation isinserted between the edges 68 of the threaded lock 60 and the top 29 ofthe handle 24. It will be appreciated that the end of the drill guidelumen 18 assembly may be similarly shaped such that rotation of thehandle 24 may be limited by a threaded lock 60 without an elongatemember 12.

FIG. 9 is a cross-sectional view of yet still another embodiment of amovable coupling 30. The movable coupling 30 comprises a bushing 40, acollar 32, the handle 24, and a threaded lock 60. At least a portion 29of the handle 24 is threaded to engage the threaded lock 60. Thethreaded lock 60 comprises a knob 62 and a threaded area 68. Thethreaded area 68 of the threaded lock 60 is adapted to engage thethreads of the portion 27 of the handle 24, for example when the knob 62is turned. When the threaded lock 60 is not engaged, the handle 24 mayfreely rotate about the bushing 40. When the threaded lock 60 is engaged(e.g., by being substantially screwed into the handle 24), the edge 70of the threaded lock 60 bears against the edge 72 of the collar 32,which causes the edge 74 of the collar 32 to bear against the bushing40, thereby limiting the rotation of the handle 24. In some embodiments,the edge 70 of the threaded lock 60, the edges 70, 72 of the collar 32,and/or the bushing 40 include teeth, grit, or similar members to enhanceeffects of the rotation limitation. In some embodiments, a material orlayer that enhances the effects of rotation limitation is insertedbetween the edge 70 of the threaded lock 60 and the edge 72 of thecollar 32 and/or between the edge 74 of the collar 32 and the bushing40.

A method of positioning a drill guide lumen 18 of the embodimentsdescribed above comprises positioning the drill guide lumen 18 with thehandle 24 in a first position and moving the handle 24 from the firstposition to a second position while the drill guide lumen 18 remainssubstantially stationary. In certain embodiments, after positioning thedrill guide lumen 18 with the handle 24 in a first position, a button 46is depressed, thereby disengaging a flange 34 of a collar 32 from abushing 40 within a movable coupling 30, before the handle 24 is movedto the second position. Once the handle 24 is in the second position,the button 46 is released, thereby allowing the flange 34 of the collar32 to engage the at least one of the plurality of recesses 42 of thebushing 40. With the handle 24 positioned to not impede the use of adrill, a drill can secure a bone screw through the drill guide lumen 18.

Although this invention has been disclosed in the context of certainpreferred embodiments and examples, it will be understood by thoseskilled in the art that the present invention extends beyond thespecifically disclosed embodiments to other alternative embodimentsand/or uses of the invention and obvious modifications and equivalentsthereof. In addition, while several variations of the invention havebeen shown and described in detail, other modifications, which arewithin the scope of this invention, will be readily apparent to those ofskill in the art based upon this disclosure. It is also contemplatedthat various combinations or sub-combinations of the specific featuresand aspects of the embodiments may be made and still fall within thescope of the invention. It should be understood that various featuresand aspects of the disclosed embodiments can be combined with, orsubstituted for, one another in order to form varying modes of thedisclosed invention. For all the embodiments described above, the stepsof the methods need not be performed sequentially. Thus, it is intendedthat the scope of the present invention herein disclosed should not belimited by the particular disclosed embodiments described above, butshould be determined only by a fair reading of the claims that follow.

What is claimed is:
 1. A drill guide comprising: at least one drillguide lumen including a proximal opening, a distal opening, and alongitudinal opening therebetween; and a handle coupled to the at leastone drill guide lumen, the handle movable between a first positionrelative to the at least one drill guide lumen and a second positionrelative to the at least one drill guide lumen.
 2. The drill guide ofclaim 1, further comprising an elongate member including a first end, asecond end, and a longitudinal axis therebetween, wherein the at leastone drill guide lumen is mechanically coupled proximate to the first endof the elongate member and wherein the handle is mechanically coupledproximate to the second end of the elongate member.
 3. The drill guideof claim 1, further comprising a plurality of drill guide lumens coupledto the handle.
 4. The drill guide of claim 1, wherein the handle isconfigured to rotate between the first position and the second position.5. The drill guide of claim 1, wherein the first position comprises afirst angular position of the handle relative to the at least one drillguide lumen and the second position comprises a second angular positionof the handle relative to the at least one drill guide lumen.
 6. Thedrill guide of claim 5, wherein the handle is configured with a fixedangular position transverse to the longitudinal opening of the at leastone drill guide lumen.
 7. The drill guide of claim 1, wherein the firstposition comprises a first angular position of the handle transverse tothe longitudinal opening of the at least one drill guide lumen and thesecond position comprises a second angular position of the handletransverse to the longitudinal opening of the at least one drill guidelumen.
 8. The drill guide of claim 7, wherein the handle is configuredwith a fixed angular position relative to the at least one drill guidelumen.
 9. The drill guide of claim 1, wherein the handle is movablycoupled to the at least one drill guide lumen with a locking mechanism,the handle movable between the first position and the second position inan unlocked state and immovable between the first position and thesecond position in a locked state.
 10. The drill guide of claim 9,wherein the locking mechanism comprises: a bushing including a pluralityof recesses; and a collar disposed around the bushing, the collarincluding a flange configured to at least partially fill at least one ofthe plurality of recesses when the handle is in the locked state. 11.The drill guide of claim 10, wherein the bushing is mechanically coupledto the drill guide lumen with a fastener.
 12. The drill guide of claim10, wherein the plurality of recesses are configured to permit rotationof the handle in a first direction and are configured to limit rotationof the handle in a second direction substantially opposite the firstdirection.
 13. The drill guide of claim 10, wherein the handle isconfigured to transition between the locked state when the flange atleast partially fills at least one of the plurality of recesses and theunlocked state when the flange does not at least partially fill at leastone of the plurality of recesses.
 14. The drill guide of claim 9,wherein the locking mechanism comprises a threaded lock including a knoband a threaded portion.
 15. The drill guide of claim 14, wherein thethreaded portion is configured to engage a threaded portion of thehandle.
 16. The drill guide of claim 14, wherein the threaded portion isconfigured to engage a threaded portion of the drill guide lumenextending through the handle.
 17. The drill guide of claim 14, whereinthe threaded portion is configured to engage a threaded portion of theelongate member extending through the handle.
 18. The drill guide ofclaim 9, wherein the handle is configured to transition between thelocked state and the unlocked state by manipulating a button.
 19. Thedrill guide of claim 9, wherein the handle is configured to transitionbetween the locked state and the unlocked state by manipulating a lever.20. The drill guide of claim 9, wherein the handle is configured totransition between the locked state and the unlocked state bymanipulating a switch.
 21. The drill guide of claim 9, wherein thehandle is configured to transition between the locked state and theunlocked state by manipulating a knob.
 22. The drill guide of claim 1,wherein the first position comprises a first translational position ofthe handle relative to the at least one drill guide lumen and the secondposition comprises a second translational position of the handlerelative to the at least one drill guide lumen.
 23. The drill guide ofclaim 22, wherein the handle is configured to slide between the firsttranslational position and the second translational position.
 24. Amethod of positioning a drill guide lumen having a longitudinal axis,the method comprising: providing a drill guide lumen coupled to amovable handle; positioning the drill guide lumen with the handle in afirst position; and moving the handle from the first position to asecond position while the drill guide lumen remains substantiallystationary.
 25. The method of claim 24, wherein moving the handlecomprises rotating the handle from the first position to the secondposition.
 26. The method of claim 24, wherein moving the handlecomprises rotating the handle about a pivot point on the drill guidelumen.
 27. The method of claim 24, wherein moving the handle comprisestranslationally sliding the handle.
 28. The method of claim 24, whereinmoving the handle comprises manipulating a locking mechanism.
 29. Themethod of claim 24, further comprising using a drill to insert a bonescrew through the drill guide lumen.